Provider Demographics
NPI:1174666168
Name:VALLEY INDUSTRIAL MEDICAL GROUP
Entity Type:Organization
Organization Name:VALLEY INDUSTRIAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ALCOCER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:559-685-8800
Mailing Address - Street 1:755 E TERRACE AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2175
Mailing Address - Country:US
Mailing Address - Phone:559-685-8800
Mailing Address - Fax:559-685-9366
Practice Address - Street 1:755 E TERRACE AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2175
Practice Address - Country:US
Practice Address - Phone:559-685-8800
Practice Address - Fax:559-685-9366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21545146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty